Last month I interviewed Sandra Pertot for an episode of Sex Out Loud. It was an amazing show filled with great audience questions…and we didn’t even get to them all! Pertot was generous enough to take the time to provide answers to everyone who wrote in to us. Enjoy this guest edition of Ask Tristan, courtesy of expert psychologist, Sandra Pertot.

When I met my wife, (in our late 30’s) we would have sex all the time. We used to joke that our sex life needed a HMO. She had to get a Hysterectomy a couple of years later due to (fucking) cancer. She refused hormone treatments and her libido “Fell off a cliff.” as she says. We are now in our early 40’s, and have had sex once in the last year and a half. She did not have an orgasm. I have tried to be understanding in all of this and have not cheated on her, but because I know she doesn’t want to, I have resigned myself to not having sex, so on the rare occasion that she says she might want to do it, I’m either not prepared, or worried that she’s not enjoying it and just “throwing me a bone,” so to speak.

Cancer changes many aspects of a person’s life, and the couple’s sexual relationship is often hit hard. In your wife’s case, her hysterectomy has added to the complex recovery from a life-threatening illness. It is likely that your wife is grieving the loss of her sex drive and the wonderful sex life she had with you while at the same time being grateful to still be alive. It sounds like you have a very strong emotional relationship, and if you are going to rebuild your sex life, this is where to start. Firstly, I would encourage you to talk about your joint grief of the loss of something that was so special. Then talk about what you each miss most – is it the closeness, the sensuality, the arousal and orgasm? There’s a good chance that your wife misses the intimacy as much or more than the arousal and orgasm (not that this isn’t important!), and if so this is the basis for building a sex life. If your wife feels she can come to sex without the expectation that she will be as she was before, and explore the sensual and emotionally reassuring aspects of sex with someone she loves, you may find she has reasons to say yes to sex more often. At the same time, she may be willing to meet your needs even though she doesn’t feel the same way. This is far from “throwing you a bone”: individuals can be very different in their sexual wants and needs and still have a satisfying sex life, even if there is the sadness that it isn’t what you had before.

I have been in a relationship for over 20 years. We have had times where mismatch in libido has switched back and forth (kids can do that), but generally it evens out (and who says masturbation is a problem?). The one thing that has had the biggest impact is my partner using anti-depressants. He doesn’t want to give up the benefits of the medication (I don’t want him to either), but the side effects are a challenge. He experiences loss of libido and then quite often when he IS turned on, he ends up not being able to come. The doctors just disregard the impact of the sexual problems. I am not saying our sex life is bad, but this is a challenge that I think is fairly common but not discussed a lot.

Unfortunately some anti-depressants do have these sexual side effects, and it is disappointing the prescribing doctor is not comfortable discussing this with you. There are some anti-depressants that are thought to have less impact on sexual functioning, so I would encourage you to seek out a medical practitioner who would explore this option. However, it may be that the medication he is on is the best one for his depression, and that leaves you and your partner to come to terms with this ongoing change if your sexual relationship. It sounds like you have done quite well in adjusting to the new relationship, but it can still be disappointing for you both. Generally in this situation if the couple explore sensual pleasure together (cuddles, massage), then if one partner becomes aroused and not the other, it is okay for the turned on partner to enjoy those feelings and not feel guilty.

One thing I would suggest is that when your partner is able to arouse, does he notice if his thoughts are able to stay connected to good sexual feelings, or do they wander into worrying about coming? If he has trouble staying focused, he might benefit from developing mindfulness skills. He might also want to explore activities that will give him stronger stimulation, such as experimenting with sex toys. Unfortunately, though, sometimes nothing triggers orgasm so he needs to recognise when his feelings and thoughts have shifted from “this feels good” to “this feels like hard work”, and at that point it is best if he stops trying to come and allow his arousal to subside, as frustrating as that may be.

My partner and I just had the most stressful year of our lives – job changes, living temporarily with no privacy, moving to a new town – so the sex life got backburnered. Now we’re in a better place, but my physical desire hasn’t gotten the message. I’ve always been a regular masturbator, but even that has felt more utilitarian than sexy. I’m also the Top in the relationship and feel the pressure is on me to instigate, but I’d like to switch more often. Can you talk a bit about how dealing with changing libido and sexual dynamics with regards to desire, roleplay, domination?

What is great to hear is that even though your physical desire has gone down, you haven’t given up on sex! The more we learn about sex drive for men and women, the more we understand that there is much more to it than a physical urge, so if you are expecting that to be the trigger for sex, you may be missing some opportunities. However, it is important that you avoid masturbation and sex as a way of coping with negative feelings such as boredom, stress and fatigue. Instead, notice feelings of well-being – feeling close to your partner, life is good, and so on – then see if that is a good time for sex or masturbation. Don’t expect sex to be as it was before, at least not immediately; begin with sensual and gentle touch. Stay connected to good feelings and you may find your arousal and desire kicks in.

The key to all good sexual relationships is communication, and good communication depends of self-confidence (I’m not stupid/inadequate/weird because I feel this way) while at the same time accepting that your partner may not want what you want or feel the same way about the things that give you pleasure. Some people don’t initiate sex because they just don’t think of it, others avoid initiating because they worry their partner will assume they are hot and ready to go, when they may be still quite unaroused. Check out with your partner what is happening – if they just don’t think about it, maybe suggesting a cue like being the initiator once a week (or month . . .) might help, and if the worry is about what you will expect, let them know that you will enjoy any initiation and go from there!

If you want to change your usual position and to introduce roleplay and domination, talk to your partner about what you would like in a confident and respectful way, and be curious about what they think about this. Obviously it is difficult if your partner is definitely against any change, but if it doesn’t come across as a demand or a judgement if your ideas aren’t met with instant enthusiasm, your partner may be willing to try it out. At the same time, make sure you know what makes sex good for your partner, so that they know that this isn’t just about you getting what you want. In an ideal world, you would both want the same things and get the same satisfaction, but for many couples this isn’t how it is. In my view, couples who willingly compromise in their sexual relationship so both partners get what they want some of the time develop a depth of understanding that perhaps couples for whom it all happens easily don’t experience.

Different sex drives? Changes in libido? Oh, we have those. Since my encounter with cancer a two years ago (I’ve been all better over a year), my sex drive has been nearly nil. My partner’s drive, however, is just as strong as it’s always been. We’ve always been poly, but neither of us has had other partners for a while. Fortunately, we also have a power dynamic. We’ve kept close and him happy by working the power exchange into it – chastity device, controlled masturbation, and the like. He still gets to have me involved in his sex life, and I don’t have to feel guilty for not wanting sex. I still do feel guilty frequently and miss my sex drive deeply, though. Got any other tips on how to cope with a nearly-absent libido?

Congratulations on your recovery from cancer and your determination to keep your sex life going even though your desire has lessened. I’m always curious about why people feel guilty about not feeling sexual, because guilt implies you have done something wrong, and to me you are doing everything right in such a difficult situation. Feelings of loss, disappointment and sadness, on the other hand, are completely natural and healthy when something you value has been lost. Sadly, I don’t have any tips for boosting your libido as I’m guessing you are already doing as much as possible. The best suggestion I can give is to shift your focus from what you used to feel that signalled sexual interest, and look for other cues such as a feeling of well-being, feeling physically well, emotionally content, and so on. Focus on what is present now rather than what is missing. I would encourage you to explore other ways for sex to be initiated, which might in the first instance be more about gentleness and soft touch, which can release oxytocin (sometimes known as the cuddle hormone or hormone of bonding), and this can sometimes be a springboard for sexual arousal – perhaps not as you felt it before, but still a lovely buzz and a soft but satisfying orgasm.

Mismatched libidos, also known as desire discrepancy, is the most common cause of distress in a sexual relationship. This week on Sex Out Loud we welcome expert Sandra Pertot, author of When Your Sex Drives Don’t Match: Discover Your Libido Types to Create a Mutually Satisfying Sex Life, to discuss the biology and psychology of this issue which affects most every sexual relationship at some point in time. Libido is much more than how often a person wants sex: it encompasses many elements, including what triggers arousal and what dampens it, the importance of sex compared to other parts of a relationship, the meaning of sex for each individual, what is pleasurable during sexual activity, and so on.

This week’s show is live, so find out all the ways to listen here so you can call in with questions at 1-866-472-5788, join the discussion on Facebook or Twitter, or e-mail me via tristan(at)puckerup.com and I’ll read them live on the air!

Sandra Pertot is currently in private practice as a clinical psychologist and sex therapist. For more than thirty five years she has specialised in the field of human sexuality. The presenting problems include low libido, mismatched libidos, erectile dysfunction, anorgasmia, rapid ejaculation, delayed ejaculation, vaginismus; sexual assault victims (male and female); sexual identity issues; impulsive/compulsive sexual behaviours; and non-sexual presentations in the general area of mental health, such as anxiety disorders, depression and so on. In addition, she presents one, two and three day workshops for health professionals on the assessment and management of sexual problems.

The show airs in the United States live on Friday, October 4th at 8 pm ET / 5 pm PT…..and for our Australian listeners, you can listen to it live on Saturday, October 5th at 10 am AEST.